A comparison of methods of plasmapheresis for the treatment of late antibody mediated rejection in kidney transplant recipients

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Caliskan Y., Mirioglu S., Dirim A. B., Ozluk Y., Yegit O. O., Aksoy E., ...More

THERAPEUTIC APHERESIS AND DIALYSIS, no.3, pp.428-434, 2023 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2023
  • Doi Number: 10.1111/1744-9987.13937
  • Journal Name: THERAPEUTIC APHERESIS AND DIALYSIS
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, MEDLINE
  • Page Numbers: pp.428-434
  • Keywords: antibody mediated rejection, kidney transplantation, plasmapheresis, rejection, HUMORAL REJECTION, ALLOGRAFT-REJECTION, PLASMA-EXCHANGE, RITUXIMAB, IMMUNOADSORPTION, OUTCOMES, THERAPY, RESCUE
  • Istanbul University Affiliated: Yes

Abstract

Introduction We compared the outcomes associated with plasma exchange (PE), double filtration plasmapheresis (DFPP), or immunoadsorption (IA) in the treatment of late antibody mediated rejection (AMR). Methods Sixty-nine kidney transplantation (KTx) recipients with late AMR were retrospectively categorized according to management with PE (n = 30), DFPP (n = 22) or IA (n = 17). Allograft loss was compared across treatment groups by Kaplan-Meier analysis and Cox regression. Results Study groups were similar regarding age, sex, donor type, kidney function, donor specific antibodies, and post-KTx follow-up time. Five-year graft survival trended higher with IA (70.6%) compared to PE (36.7%) and DFPP (27.3%) (p = 0.06). In multivariate Cox regression, baseline eGFR (HR per ml/min/1.73 m(2) [95% CI]; 0.96 [0.94-0.99]), rituximab use (HR [95% CI]; 0.42 [0.21-0.84]), interstitial inflammation (i) (HR [95% CI]; 2.05 [1.13-3.69]), and transplant glomerulopathy (cg) (HR [95% CI]; 1.46 [1.13-1.87]) were associated with graft loss. Conclusion These results motivate the need for continued assessment of rituximab and plasmapheresis in larger studies.